There is a pressing need for interventions that reduce risk for suicide in later life. Older adults in the U.S. have the highest rate of suicide and are the fastest growing segment of the population. We can anticipate a large rise in the number of older adults who die by suicide in coming decades. This application is in response to RFA-CE-10-006. Consistent with the CDC's key strategy of reducing suicide by promoting connectedness, our long-term goal is to reduce late life suicide-related morbidity and mortality by leveraging the resources and expertise of the aging services provider network (ASPN) to address unmet social needs of community-dwelling older adults. Our objectives with this proposal are (1) to examine whether linking socially disconnected seniors with peer supports through the Retired and Senior Volunteer Program (RSVP) is effective in reducing risk for suicide, and (2) to test an hypothesized mechanism for the association of social disconnectedness and suicidal ideation and behavior informed by the Interpersonal Theory of Suicide. We will recruit 400 primary care patients (200 men and 200 women) over age 60 years who endorse feeling lonely and/or as if they are a burden on others. They will be randomly assigned to either of two conditions. Those assigned to The Senior Connection (TSC) will either be paired with a peer companion or, if they prefer and are eligible, be trained and placed as a peer companion for others by RSVP. The comparison group will receive no further intervention ("care-as-usual" [CAU]). Subjects will be followed for up to 24 months with repeated in-home (baseline, 12, and 24 months) and telephone assessments (3, 6, and 18 months). The study has four specific aims: (1) To compare the impact of TSC and CAU on social connectedness of older adult primary care patients;(2) to compare the effectiveness of TSC and CAU in reducing factors associated with proximal risk for suicidal behavior;(3) to determine if changes in measures of older adults'social connectedness mediate the relationship between social connectedness and suicide risk;and (4) is to examine whether responsiveness to the intervention differs by gender. PUBLIC HEALTH RELEVANCE: The Retired and Senior Volunteer Program (RSVP) is offered in communities nationwide by social service agencies that are dedicated to maintaining the independence and quality of life of older adults. Their expertise and resources are well suited to the reduction of suicide risk in later life. If RSVP is shown to be effective in reducing suicidal ideation and increasing connectedness, it will be easily disseminated across the aging services provider network as a means to prevent suicide among seniors at risk.